Experiences of male patients and wife-caregivers in the first year post-discharge following minor stroke: a descriptive qualitative study

Structured follow-up pathway to address unmet needs after transient ischaemic attack and minor stroke (SUPPORT TIA): Feasibility study and process evaluation

BACKGROUND

Care following transient ischaemic attack (TIA) and minor stroke is variable and often leaves patients feeling abandoned and uncertain. We developed a theoretically-informed, multifaceted intervention which comprised nurse-led, structured follow-up at 4 weeks after TIA/minor stroke to identify and address patient needs. This study evaluated the feasibility and acceptability of both the intervention and procedures to inform a future randomised controlled trial.

METHOD

We conducted a multicentre, randomised feasibility study with mixed-methods process evaluation (ISRCTN registry reference: ISRCTN39864003). We collected patient reported outcome measures (PROMs) at 1, 12 and 24 weeks and clinical data at baseline and 24 weeks. The process evaluation comprised qualitative interviews with a sub-sample, feedback questionnaires, and observations of intervention delivery.

RESULTS

We recruited 54 patients over 12 months, achieving 90% of the target sample size (n = 60). PROMs return rates were 94.4% (51/54), 85.2% (46/54) and 71.1% (27/38) at 1, 12, and 24-weeks, respectively. Intervention fidelity was high and the intervention largely aligned with the theoretical underpinnings. The process evaluation illustrated how patients benefitted from the intervention through support they would not have received through usual care. This included direct referral or signposting to support services, information and education, actionable advice, and reassurance about and normalisation of recovery. The trial design was feasible and acceptable for both patients and clinicians.

CONCLUSION

Nurse-led, structured follow-up after TIA and minor stroke is feasible, acceptable and valued by patients and clinicians. Our intervention can identify and help address unmet needs. A definitive randomised trial to evaluate intervention effectiveness and cost-effectiveness is feasible and acceptable.

Influence of Partnership Relationships on Long-Term Neurological Rehabilitation in Germany: Protocol for a Qualitative Retrospective Study

BACKGROUND

Acquired neurological diseases entail significant changes and influence the relationship between a patient and their significant other. In the context of long-term rehabilitation, those affected collaborate with health care professionals who are expected to have a positive impact on the lives of the affected individuals.

OBJECTIVE

This study aims to examine the changes in the relationship between the patient and their loved ones due to acquired neurological disorders and the influence of health care professionals on this relationship.

METHODS

Through sociogenetic type building, we will identify different types of patient-caregiver dyads and their effects on health care professionals and vice versa. The results will then be integrated into a model based on the theory of symbolic interactionism and Baxter's Relational Dialectics Theory.

RESULTS

This study is not funded and was approved by the ethics committee of the German Society for Nursing Science, and it complies with the Declaration of Helsinki. The data collection started in June 2024 based on narrative couple interviews and is running. We assume that patients and their relatives will demonstrate heterogeneity as individuals, as well as in their interactions within the dyad, regarding certain orientations such as coping with illness, motivation for therapy, and coping strategies.

CONCLUSIONS

Our findings address a biopsychosocial perspective that enhances treatment approaches in neurological long-term care. Understanding the influence of professionals on dyadic couple relationships can improve rehabilitation effectiveness by tailoring therapeutic approaches to various patient types, relatives, and dyadic relationship constellations. This fosters patient- and family-centered therapy in line with holistic care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63949.

Physiotherapists' and occupational therapists' experiences with cross-sectoral coordination of rehabilitation for people with mild stroke - a qualitative interview study

PURPOSE

To meet the needs of people with mild stroke, multidisciplinary, person-centred, cross-sectoral rehabilitation is internationally recommended. However, there seem to be gaps in the rehabilitation process. The aim of this study was to investigate how occupational therapists and physiotherapists experience working in cross-sectoral rehabilitation for people with mild stroke.

MATERIALS AND METHODS

Data were generated through interviews with occupational therapists and physiotherapists working in four different Danish rehabilitation settings. Four group interviews and two individual interviews with a total of 19 participants were conducted. Ricoeur's theory of interpretation was used to interpret and discuss the data.

RESULTS

Four themes were identified: the risk of overlooking symptoms: better safe than sorry; varying degrees of involvement of people with mild stroke; spontaneous involvement of relatives; and contextual challenges for coherence in the rehabilitation process.

CONCLUSION

The therapists experienced challenges in coordinating rehabilitation across sectors due to the timing of the needs assessment and contextual challenges. They used a preventive strategy of sending a plan or referral for later re-assessment. The therapists involved people with mild stroke to varying degrees. They involved relatives spontaneously. For successful rehabilitation, ongoing assessment, recognition of collaboration factors and relative involvement are essential.

The impact of caregiving on the roles and valued activities of stroke carers: A systematic review of qualitative studies

OBJECTIVE

To understand the experiences of informal carers and the impact of role and activity changes on their health and wellbeing.

METHODS

A systematic search of CINHAL, MEDLINE, Embase, APA PsycInfo, and Web of Science was conducted. Studies were eligible if they included informal stroke carers (≥18 years), used a qualitative methodology, explored the roles and valued activities of stroke carers, and were published in English. The 10-item Critical Appraisal Skills Programme checklist for qualitative studies was used to assess methodological quality. The results of the included studies were thematically synthesised.

RESULTS

A total of 36 qualitative studies were included and four overarching themes were identified: (1) Life adjustment; (2) Changing role and identity; (3) Changing activities: From meaningful to purposeful; and (4) Understanding and supporting carers.

CONCLUSION

The sudden nature of stroke requires major readjustment in the carers life that has implications on their relationships, roles, and activities, subsequently impacting on their health and wellbeing. Health professionals and researchers should collaborate with stroke carers to identify their valued activities and implement realistic strategies to maintain these activities. Future interventions designed for carers should implement education about the importance of participating in valued activities and strategies to maintain these activities.

Acceptance of disability in stroke: a systematic review

BACKGROUND

Evidence for the association between acceptance of disability (AOD) and positive rehabilitation outcomes, as well as for the use of AOD measurements in stroke rehabilitation practice, has increased in the international literature in the last decade. However, measurement tools for AOD are heterogenous and there has not been a systematic review summarizing the current evidence on the use of AOD measures and factors associated with AOD.

OBJECTIVE

This study aimed to summarize current evidence on measurement tools used, present existing AOD scores in people with stroke and identify risk factors for and protective factors against poor AOD in people with stroke.

METHODS

The original design and protocol of this systematic review were registered with PROSPERO. The included studies were published from 2008 to 2020 and identified from 5 databases-PubMed, EMBASE, CINAHL Plus, PsycInfo, and the Cochrane Library-using the following inclusion criteria: participants diagnosed with stroke and aged ≥16 years, measurement of AOD, and published in English in a peer-reviewed scientific journal. Review articles were excluded.

RESULTS

Five measurement tools for AOD were reported. The Revised Acceptance of Disability Scale (ADS-R) and the acceptance subscale of the Illness Cognition Questionnaire (ICQ) had the highest internal consistency. Scores ranged from 71.7 to 74.2 on the ADS-R, 16.9-18.3 on the ICQ, 16.5-26.9 on the Acceptance of Illness Scale, and 87.8-93.2 on the Attitudes towards Disabled Persons Form A. Poorer function and depressive symptoms were associated with poor AOD, whereas religious beliefs, support from others, and an understanding of stroke were associated with better AOD.

CONCLUSIONS

The ADS-R and the acceptance subscale of the ICQ are currently the most reliable measurement tools for measuring AOD in people with stroke. Further research to validate the measurement tools is required. This may help to identify people who require additional support.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42017077063; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77063.

Using a Mixed-Method Approach to Explore the Factors Influencing the Family Resilience of Stroke Survivors in China

Background

Stroke is a critical public health issue in China that necessitates a closer examination of family resilience (defined here as the collective capacity of individuals, families and communities to effectively navigate challenges, recover from adverse events and foster positive adaptation). Amid rising stroke incidence, this study addresses the dearth of research on family resilience among stroke survivors in China, aiming to assess its level, identify influencing factors and establish coping strategies for family caregivers.

Methods

This mixed-methods research employed a sequential explanatory design. Questionnaires were distributed to 258 stroke survivors and their family members at outpatient follow-up visits. In the first stage (ie the quantitative research stage), the research tools for data collection included a general demographic sociological data questionnaire, the Family Resilience Assessment Scale (FRAS), the Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Caregiver Burden Scale, the Family Functioning Scale and the Social Support Rating Scale. Quantitative data were analysed using IBM SPSS 26.0 software, utilising descriptive statistics for summarising sociodemographic characteristics and conducting analyses, such as independent-sample t-tests, one-way analysis of variance and Spearman correlation analysis. The second stage (ie the qualitative research stage) involved complementing and validating the data, developing a quantitative-qualitative interview framework and selecting participants for interviews. Colaizzi's seven-step analysis was applied to analyse interview data. In the third stage, the quantitative and qualitative research results were integrated, and a comprehensive analysis was performed to obtain an accurate conclusion.

Results

A total of 242 families responded to the questionnaire (response rate: 93.8%). In total, the mean age of stroke survivors was 61.86 ± 8.76 years old, and 69.8% were male. The quantitative results showed that the FRAS mean score was (185.33 ± 24.78), which was above the medium level. The multiple linear regression analysis confirmed that family function was the strongest influencing factor on family resilience (β = 0.948, p < 0.01). The qualitative analysis revealed four themes of family adaptation experience: loss of independence and certainty, facing threats and challenges, seeking family advantage resources and adopting coping strategies.

Conclusion

This hybrid study sheds light on the adaptation process of the families of stroke survivors, revealing family function as the primary influencer of resilience. Recognising that eliminating risk factors is challenging, our suggestion is for clinical practitioners to emphasise family strengths and implement resilience-oriented interventions. Focusing on enhancing coping abilities and fostering adaptation within families can aid in the rehabilitation process, promoting the well-being and growth of both the family unit and individual members, while alleviating caregiver burden.

Outcomes in Patients with Minor Stroke: Diagnosis and Management in the Post-thrombectomy Era

In the era of mechanical thrombectomy and better preventative strategies, a higher number of patients are being discharged home from the hospital with the so-called minor strokes. This has significantly changed the landscape of stroke recovery. Unfortunately, while symptoms may be categorized as mild compared to individuals with higher NIH Stroke Scale scores, the physical, cognitive, and emotional sequelae can be disabling and result in failure to return to work and poor quality of life in a population with significant potential to recover fully. In this review, we discuss the current state of minor stroke, the most common pattern of resulting deficits, what is known about the underlying pathophysiology that leads to a relatively global pattern of impaired cognition following an infarct in any location, and special considerations for treatment based on this population's unique needs. Raising awareness of the current morbidity associated with minor stroke, the need for a uniform definition that allows for comparisons of individuals across studies, and further research focused on this population to optimize outcomes, has the potential to significantly improve recovery.

Associations among disability, depression, anxiety, stress, and quality of life between stroke survivors and their family caregivers: An Actor-Partner Interdependence Model

AIM

To explore the effects of disability, depressive, anxiety and stress symptoms on patients' and their partners' quality of life (QoL) using the actor-partner interdependence model (APIM).

DESIGN

A cross-sectional study using actor-partner interdependence model.

METHODS

We recruited 183 dyads of stroke survivors and their family caregivers in Indonesia. The World Health Organization Disability Assessment (WHODAS 2.0), Depression, Anxiety and Stress (DASS-42) and Rand Short Form Health Survey (SF-36) were used to measure disability, depressive, anxiety and stress symptoms and QoL of stroke survivors and family caregivers. The actor-partner interdependence model was tested using multilevel modelling. The actor-partner interdependence mediation model (APIMeM) was applied to estimate the direct and indirect effect.

RESULTS

Disability had actor effects on stroke survivor's overall QoL and partner effect on family caregiver's overall QoL. More severe disability of stroke survivors was associated with a lower overall QoL of their own and that of family caregiver's overall QoL. Depressive symptoms of stroke survivors had actor effects on stroke survivors' overall QoL and partner effects on family caregivers' overall QoL. Actor and partner effects also exist on family caregiver's depression symptoms to their own overall QoL and stroke survivor's overall QoL. Moreover, higher anxiety symptoms were associated with lower levels of their own and partner's overall QoL in both stroke survivors and family caregivers. Stroke survivor's stress symptoms also negatively associated with their own and family caregiver's overall QoL. However, a family caregiver's stress without a partner effects on stroke survivor's overall QoL. The APIMeM analysis showed that disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, disability mediated by stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS).

CONCLUSION

The findings suggest that stroke survivors and family caregivers may influence each other during the caregiving process and social life. The disability of stroke survivors, and the depression, anxiety and stress symptoms of stroke survivors and family caregivers affect their own QoL and their partners' QoL. Disability of stroke survivors directly decreased their own overall, physical (PCS) and mental QoL (MCS). Also, it indirectly via stroke survivor's depression, anxiety and stress symptoms decreased both stroke survivor's and family caregiver's physical (PCS) and mental QoL (MCS).

IMPACT

Dyadic actor-partner interdependence models have shown promising potential to predict the QoL among patients and family caregivers. The dyadic effects of disability, depression, anxiety and stress symptoms on the QoL of stroke survivors and family caregivers can be applied to guide the future development of nursing intervention addressed decreasing depression, anxiety and stress symptoms to optimize health outcomes among stroke survivors and their family caregivers.

Cultural and Social Factors in Care Delivery Among African American Caregivers of Persons With Dementia: A Scoping Review

Cultural and social factors significantly influence the care provided to persons with dementia. This scoping review aimed to map emerging evidence on the influence of cultural and social factors on care delivery among Africa American caregivers of persons with dementia, especially during the COVID-19 pandemic. Using a systematic scoping review approach, we identified 21 studies on cultural and social factors influencing care delivery. The search included EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and Epistemonicos. A narrative synthesis of the data revealed that cultural and social factors greatly influence African American caregivers of persons with dementia and COVID-19 in care delivery, who perceive caregiving as a responsibility and not just a job. These caregivers are additionally guided by their racial identity and faith beliefs, integrating family values and culture into caregiving. African American caregivers showed compassion and resilient care selfperceptions. Supporting compassionate care delivery by African American caregivers requires an understanding of the social and cultural factors which drive their commitment to quality care for older adults with dementia in a pandemic environment.

Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation

Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.

The experiences of spousal and adult child caregivers of stroke survivors in transitional care: A qualitative systematic review

AIM

To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care.

DESIGN

This is a qualitative systematic review.

DATA SOURCES

Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included.

REVIEW METHODS

The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta-aggregative approach recommended by JBI.

RESULTS

A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated.

CONCLUSION

Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role.

IMPACT

The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors.

Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta-synthesis

BACKGROUND AND OBJECTIVE

Acquired brain injury (ABI) can result in considerable life changes. Having choice and control over daily life is valued by people following ABI. This meta-synthesis will analyse and integrate international research exploring perspectives of choice and control in daily life following ABI.

METHODS

Databases were searched from 1980 to 13 January 2022 for eligible qualitative studies. After duplicates were removed, 22,768 studies were screened by title and abstract, and 241 studies received full-text assessment with 56 studies included after pearling. Study characteristics and findings were extracted that related to personal perspectives on choice and control by people with an ABI (including author interpretation and quotes). Data from each study were coded and then segments of coded data across the studies were compared to create multiple broad categories.

FINDINGS

Findings were then reduced from categories into 3 overarching themes with 12 subthemes. These themes were: (1) feeling like a second-class citizen; (2) reordering life and (3) choosing a path. Participants with an ABI tussled between their feelings of loss following brain injury and their thinking about how they start to regain control and become agents of their own choices. The themes describe their sense of self, their changed self and their empowered self in relation to 'choice and control'.

CONCLUSIONS

Re-engaging with choice and control after ABI is dynamic and can be challenging. Health professionals and supporters need to facilitate a gradual and negotiated return to agency for people following ABI. A sensitive and person-centred approach is needed that considers the readiness of the person with ABI to reclaim choice and control at each stage of their recovery. Clear service or process indicators that are built on lived experience research are needed to facilitate changes in service delivery that are collaborative and inclusive.

PATIENT OR PUBLIC CONTRIBUTION

This review included the voices of 765 people living with ABI and was conducted by a diverse team of allied health professionals with practice knowledge and research experience with people following ABI. Twenty-nine of the 56 included studies had participants contributing to their design or analysis.

Factors associated with post-stroke social participation: A quantitative study based on the ICF framework

BACKGROUND

Post-stroke social participation is a major determinant of quality of life and life satisfaction. However, few data relating to participation determinants are available, especially the influence of psychological factors and factors related to the living environment.

OBJECTIVES

This study investigated determinants of post-stroke social participation within the International Classification of Functioning, Disability and Health framework.

METHODS

We contacted people with stroke who had been hospitalized in the Rhône County, included in a previous cohort study, were aged ≥18 years and were not institutionalized. The primary outcome was social participation measured with the Stroke Impact Scale (SIS) 2.0. We performed multiple hierarchical linear regressions to test the following predictors: clinical factors (stroke-related variables, limitations in Activities of Daily Living [ADL]/Instrumental ADL), personal factors (sociodemographic factors, coping strategies) and environmental factors (satisfaction with social relationships and living environment).

RESULTS

Among the 352 participants, 63% were men, and mean age was 68.7(SD 14.5) years. In the last multivariate model, variables associated with higher levels of social participation were the use of the positive thinking coping strategy (B (SD)=1.17(0.52), p = 0.03), higher perceived satisfaction with the living environment (B (SD)=0.17(0.07), p = 0.03) and fewer perceived activity limitations (B (SD)=0.55 (0.06), p < 0.001). Conversely, the seeking social support coping style (B (SD)= -1.98 (0.60), p = 0.001), and a higher number of stroke-related sequelae (B (SD)= -1.93(0.53), p = 0.001) were associated with lower social participation.

CONCLUSIONS

The identification of potentially modifiable personal and environmental factors that influence social participation provides elements to strengthen existing rehabilitation programs and opens the way for possible psychosocial interventions.

Structured follow-up pathway to support people after transient ischaemic attack and minor stroke (SUPPORT TIA): protocol for a feasibility study and process evaluation

INTRODUCTION

People who experience transient ischaemic attack (TIA) and minor stroke have limited follow-up despite rapid specialist review in hospital. This means they often have unmet needs and feel abandoned following discharge. Care needs after TIA/minor stroke include information provision (diagnosis and stroke risk), stroke prevention (medication and lifestyle change) and holistic care (residual problems and return to work or usual activities). This protocol describes a feasibility study and process evaluation of an intervention to support people after TIA/minor stroke. The study aims to assess the feasibility and acceptability of (1) the intervention and (2) the trial procedures for a future randomised controlled trial of this intervention.

METHODS AND ANALYSIS

This is a multicentre, randomised (1:1) feasibility study with a mixed-methods process evaluation. Sixty participants will be recruited from TIA clinics or stroke wards at three hospital sites (England). Intervention arm participants will be offered a nurse or allied health professional-led follow-up appointment 4 weeks after TIA/minor stroke. The multifaceted intervention includes: a needs checklist, action plan, resources to support management of needs, a general practitioner letter and training to deliver the intervention. Control arm participants will receive usual care. Follow-up will be self-completed questionnaires (12 weeks and 24 weeks) and a clinic appointment (24 weeks). Follow-up questionnaires will measure anxiety, depression, fatigue, health related quality of life, self-efficacy and medication adherence. The clinic appointment will collect body mass index, blood pressure, cholesterol and medication. Assessment of feasibility and acceptability will include quantitative process variables (such as recruitment and questionnaire response rates), structured observations of study processes, and interviews with a subsample of participants and clinical staff.

ETHICS AND DISSEMINATION

Favourable ethical opinion was gained from the Wales Research Ethics Committee (REC) 1 (23 February 2021, REC reference: 21/WA/0036). Study results will be published in peer-reviewed journals and presented at conferences. A lay summary and dissemination strategy will be codesigned with consumers. The lay summary and journal publication will be distributed on social media.

TRIAL REGISTRATION NUMBER

ISRCTN39864003.

Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers' perceived needs and incorporated three evidence-based dimensions (psychoeducation, skill-building and peer support).

DESIGN

A prospective randomised control trial.

SETTING

A community-based study conducted in Egypt.

PARTICIPANTS

A total of 110 caregivers aged ≥18 years who cared for a survivor within 6 months of stroke, with modified Rankin Scale scores of 3-5, and without other physical disabilities or terminal illnesses were recruited between December 2019 and May 2020. Participants were assigned to the intervention group (IG; n=55) and control group (CG; n=55) through open-label, parallel 1:1 randomisation.

INTERVENTION

The IG was provided with tailored multidimensional interventions for 6 months until November 2020, including three home visits, six home-based telephone calls and one peer-support session. The CG received simple educational instructions at a single visit.

OUTCOME

The participants completed the Zarit Burden Interview (primary outcome) and the WHO Quality of Life-BREF (secondary outcome) before the intervention (T0), at 3 months (T1) and at 6 months (T2).

RESULTS

No differences were observed between the characteristics of the groups at baseline (T0). The independent t-test showed no significant differences in the care burden and Quality of Life (QoL) at T1 and T2 between the groups. The intervention had no significant effect on the outcomes between or within groups over time, as shown by the repeated-measures analysis of variance. However, the group and time interaction had significant main effects on caregivers' QoL (psychological and social domains).

CONCLUSION

The main results showed that participants in the IG did not experience an improvement in the main outcomes. Nevertheless, the improvement in the psychological and social domains may have been attributed to our intervention.

TRIAL REGISTRATION NUMBER

NCT04211662.

The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature

Background and Purpose:

Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.

Method:

Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.

Results:

While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.

Conclusions:

Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.

Effect of cohabiting partners on the development of posttraumatic stress symptoms after emergency department visits for stroke and transient ischemic attack

OBJECTIVE

Partners can be beneficial for patients experiencing stressful health events such as a stroke/transient ischemic attack (TIA). During such events, however, partners may exacerbate early distress. The present study tested whether having a cohabiting partner modified the association between patients' early perceptions of threat (e.g., feeling vulnerable, helpless) and longer-term posttraumatic stress symptoms (PTSS).

METHODS

Participants (N = 328) were drawn from an observational cohort study of patients evaluated for stroke/TIA at an urban academic hospital between 2016 and 2019. Participants self-reported emergency department (ED) threat perceptions and PTSS secondary to the stroke/TIA at three days and one month post-event.

RESULTS

Cohabiting partner status modified the association of ED threat with early PTSS. Patients with a cohabiting partner exhibited a positive association between ED threat and early PTSS, B = 0.12, p < .001; those without a cohabiting partner did not, B = 0.04, p = .067. A cohabiting partner was protective only for patients who initially reported low levels of ED threat, as patients with a cohabiting partner who reported low levels of ED threat also had lower early PTSS, B = -0.15, p = .016; at high levels of ED threat, a cohabiting partner was not protective, B = -0.02, p = .68. ED threat was associated with PTSS at one month, B = 0.42, p < .001, but cohabiting partner status did not modify the association.

CONCLUSIONS

ED threat perceptions were positively associated with early PTSS only for patients with a cohabiting partner. For patients who do not initially experience a stroke/TIA event as threatening, cohabiting partners may help patients maintain psychological equanimity.

Sexuality after stroke: Exploring knowledge, attitudes, comfort and behaviours of rehabilitation professionals

BACKGROUND

Sexual dysfunction after stroke is common and is associated with poor health and quality of life outcomes. Clinical guidelines for stroke typically recommend that all stroke survivors have access to support relating to sexuality during rehabilitation. However, the extent to which rehabilitation professionals are prepared to address sexuality after stroke is unclear.

OBJECTIVE

To investigate the knowledge, comfort, approach, attitudes, and practices of rehabilitation professionals toward supporting stroke survivors with their sexuality concerns.

METHODS

Cross-sectional analytic survey design. Data were collected by using an electronic questionnaire that contained the Knowledge, Comfort, Approaches, and Attitudes towards Sexuality Scale (KCAASS) and sexuality-related practice questions. Participants were recruited from Australia, New Zealand, the United States, Canada, United Kingdom, Ireland, Singapore, and South Africa. Multiple regression was used to explore KCAASS scores and sexuality-related practices.

RESULTS

A total of 958 multi-disciplinary, stroke rehabilitation professionals participated in the study. Only 23% (n = 216) of health professionals' reported directly initiating sexuality discussions with stroke survivors. On regression analysis, professionals' practices, perception of their role in sexuality rehabilitation, sexuality training, education, age and sex predicted their knowledge of sexuality after stroke (r² = 0.44; p<0.001). Sexuality training, religious affiliation and provision of sexuality-rehabilitation services predicted comfort (r² = 0.21; p<0.001). Professionals' age and provision of sexuality-rehabilitation services predicted approach-related comfort (r² = 0.2; p<0.001). Professionals' perception of health professionals' role in sexuality rehabilitation, religious affiliation and geographical location predicted professionals' attitudes toward sexuality (r² = 0.11; p<0.001). Open-ended responses indicated that participants perceived a need to improve their competency in providing sexuality rehabilitation. The timing of training predicted knowledge (t = 3.99; p<0.001), comfort (t = 3.47; p<0.001) and the provision of sexuality-rehabilitation services (t = 3.68; p<0.001).

CONCLUSION

Findings confirm that sexuality is neglected in stroke rehabilitation and point to the need for a considered approach to the timing and nature of education.

Quickly home again: patients' experiences of early discharge after minor stroke

BACKGROUND

Patients with minor stroke experience some of the same issues as patients experiencing stroke of increased severity such as fatigue, anxiety and cognitive symptoms. It is current practice that patients with minor stroke receive accelerated treatment and care, yet studies indicate that patients find it difficult to return to their everyday lives after being discharged. We aimed to explore how patients with minor stroke experience the transitional period from the hospital through the first 2-4 weeks after an accelerated care pathway with discharge within 72 hours after stroke onset.

METHODS

A qualitative study consisting of semi-structured interviews with 11 patients experiencing first-time stroke 2-4 weeks after discharge.

RESULTS

The patients struggled to identify themselves as having had a stroke. They strived to find a new everyday life, but were challenged by existential concerns, mental fatigue and the fear of having a stroke again. Unresolved questions and misunderstandings arose, and the patients expressed a need for health professionals to support them and discuss unclear issues after discharge. Patients searched for others with similar issues in order to find a new sense of self.

CONCLUSION

Patients with minor stroke struggle with everyday life after discharge. There is a need for support after discharge from healthcare professionals with specialised knowledge of stroke. Patients also requested an opportunity to meet other patients with minor stroke.

Functional Stroke Symptoms: A Narrative Review and Conceptual Model

Stroke services have been reconfigured in recent years to facilitate early intervention. Throughout stroke settings, some patients present with functional symptoms that cannot be attributed to a structural cause. Emphasis on fast diagnosis and treatment means that a proportion of patients entering the care pathway present with functional symptoms that mimic stroke or have functional symptoms in addition to vascular stroke. There is limited understanding of mechanisms underlying functional stroke symptoms, how the treatment of such patients should be managed, and no referral pathway or treatment. Predisposing factors vary between individuals, and symptoms are heterogeneous: onset can be acute or insidious, and duration can be short-lived or chronic in the context of new or recurrent illness cognitions and behaviors. This article proposes a conceptual model of functional symptoms identified in stroke services and some hypotheses based on a narrative review of the functional neurological disorder literature. Predisposing factors may include illness experiences, stressors, and chronic autonomic nervous system arousal. Following the onset of distressing symptoms, perpetuating factors may include implicit cognitive processes, classical and operant conditioning, illness beliefs, and behavioral responses, which could form the basis of treatment targets. The proposed model will inform the development of theory-based interventions as well as a functional stroke care pathway.

Experiences of quality of life the first year after stroke in Denmark and Norway. A qualitative analysis

Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice.

"Caregiving is a full-time job" impacting stroke caregivers' health and well-being: A qualitative meta-synthesis

Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well-being. We conducted a qualitative meta-synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, 'caregiving is a full-time job' was identified, encompassing four sub-themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution-based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well-being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.

Couples coping in the community after the stroke of a spouse: A scoping review

Aim

To summarize evidence on the poststroke coping experiences of stroke patients and spousal caregivers living at home in the community.

Design

A scoping review.

Methods

Extensive searches were conducted in credible databases. Articles published in the English language were retrieved. Data were extracted based on study location, aims, study design, sample size, time after stroke and key findings.

Results

Out of 53 identified articles, 17 studies were included in the review. Five key themes were as follows: (a) emotional challenges; (b) role conflicts; (c) lack of strategies in coping; (d) decreased life satisfaction of the couples; and (e) marriage relationship: at a point of change. Couples were not sufficiently prepared to cope and manage with stroke at home on discharge from the hospital. This review emphasized the need for hospitals to implement policies to address the inadequate preparation of couples in coping with stroke.

Interpersonal relationship challenges among stroke survivors and family caregivers

A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. However, as many as 54% of families experience relationship problems after stroke and as many as 38% of couples experience overt conflict. The purpose of this study is to enhance understanding about relationship challenges among stroke dyads and to identify implications for direct practice in social work. Semi-structured interviews were conducted with N = 19 care dyads. Qualitative data were analyzed through an interpretive description lens. Seven themes about relationship challenges were identified. Findings highlight areas to consider in promoting strong relationships between survivors and family caregivers. Social workers may have the opportunity to assist dyads with disrupting negative communication cycles, strengthening empathy and collaboration, and achieving a balance so that each person's needs are met.

Factors which Influence Risk Taking and the Evolution of Social-Identity in Stroke Narratives: A Thematic Synthesis

Background: The disruption of a stroke can impact an individual’s sense of social identity. A comprehensive review is required to understand the factors and processes that influence changes in social identity following a stroke. Aims: To undertake a review of literature to discover a process of social identity evolution for people with stroke and identify the factors which influence it. Methods: A meta-ethnographic approach to review was undertaken and a subtle realist viewpoint was assumed. Studies were included if they documented experiences and perceptions relating to stroke. Eight electronic databases were searched from January 2009 until January 2019. Quality assessment and synthesis techniques were applied. Findings: Out of the 18 papers included, a total of 251 (141/251, 56% male, 109/251, 43% female, 1/251, 0.4% undisclosed) individuals were included within the synthesis. The evolution of social-identity model was developed and identified with five key stages to represent a process that individuals with stroke can experience. Factors which influence the process were identified and direct implications for clinical practice are given. Conclusion: This review has highlighted the major themes within the evolution of social identity and management strategies for risk taking to achieve a desired future. Further research is required to consider how these findings may be tested in clinical practice.

Occupational engagement following mild stroke in the Australian context using the occupational gaps questionnaire

BACKGROUND

There is a need for research to identify the impact of mild stroke on occupational engagement. The Occupational Gaps Questionnaire (OGQ) measures the difference between a person's actual and preferred occupational engagement.

AIMS/OBJECTIVES

This study aimed to test the feasibility of the English version of the OGQ, and describe occupational gaps of people with mild stroke.

MATERIAL AND METHODS

A mixed methods, cross-sectional study involving 10 people with mild stroke at 1 and/or 9 months after stroke. Quantitative data were summarised descriptively and thematic analysis explored qualitative responses.

RESULTS

Participants reported a mean of 6.7 (SD 5.1) gaps at 1-month and 3.00 (SD 2.1) gaps at 9-months. Outdoor activities, work, sports, and light home and heavy-duty maintenance were identified as gaps at both time-points. Two themes emerged from the qualitative analysis: Drivers of occupation and Occupations can be challenged or enabled. An additional finding in terms of feasibility was drawn from qualitative data: Feasibility of Conducting the OGQ with people with mild stroke.

CONCLUSIONS AND SIGNIFICANCE

The English version of the OGQ was found to be a feasible instrument for identifying occupational gaps following mild stroke and may be suitable to support research and clinical practice with this population.

TIA and minor stroke: a qualitative study of long-term impact and experiences of follow-up care

Background

Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided.

We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support.

Methods

This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care. Data was analysed using framework analysis.

Results

A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems.

Conclusion

HCPs could better communicate information about TIA/minor stroke diagnosis and secondary stroke prevention using lay language, and improve their identification of and response to important residual impairments affecting patients.

Development and validation of a quality of relationship intervention for stroke survivor-family caregiver dyads

Background: The relationship between stroke survivors and family caregivers is critical for the well-being of both dyad members. Currently, there are few interventions targeted at dyads and focused on strengthening the relationship between survivors and family caregivers.Objectives: This study reports on the development of a customizable, strengths-based, relationship-focused intervention driven by the real-world experience and advice of stroke dyads. It also describes the "tips" that survivors and family caregivers offered for dealing with relationship challenges after stroke.Methods: Content of the intervention, including relationship tips, was derived from semi-structured interviews with N= 19 stroke dyads. A modified Delphi process with a national panel of 10 subject matter experts was used to evaluate and refine the content of the intervention and the associated screening tool.Results: Seventeen domains of relationship challenges and tips were identified. Consensus was reached among experts that the intervention content was relevant to the goal of helping survivors and family caregivers maintain a strong relationship after stroke; (2) clear from the perspective of stroke survivors and family caregivers who would be using it; (3) accurate with respect to the advice being offered, and; (4) useful for helping stroke survivors and family caregivers improve the quality of their relationship.Conclusions: This study extends the limited body of research about dyadic interventions after stroke. The next steps in this line of research include feasibility testing the intervention and evaluating its efficacy in a larger trial.

Valued activities and informal caregiving in stroke: a scoping review

Purpose: Map the literature about valued activities and informal caregiving post stroke and determine the nature, extent, and consequences of caregivers' activity changes. Methods: A scoping review was undertaken, searching Pubmed, Cinahl, PsycInfo, and Google Scholar. Two researchers independently identified relevant articles, extracted study characteristics and findings, and assigned codes describing the topics and outcomes. Using thematic analysis, the main study topics and study outcomes were described. Results: The search yielded 662 studies, 30 of which were included. These were mainly qualitative and cross-sectional studies assessing caregivers' activity changes and related factors, or exploring caregivers' feelings, needs and strategies to deal with their activity challenges. Although caregivers often lost their social and leisure activities, which made them feel unhappy and socially isolated, we found no studies about professional interventions to help caregivers maintain their activities. Over the years, caregivers' activity levels generally increased. However, some caregivers suffered from sustained activity loss, which, in turn, relates to depression. Conclusion: Loss of valued activities is common for stroke caregivers. Although high-level evidence is lacking, our results suggest that sustained activity loss can cause stroke caregivers to experience poor mental health and wellbeing. Suggestions to help caregivers maintain their valued activities are presented. Implications for rehabilitation Not only stroke survivors but also their informal caregivers tend to lose their valued activities, such as their social and leisure activities. Although many caregivers manage to resume their valued activities over time, others suffer from sustained activity loss up to at least two years post stroke. Loss of valued activities in stroke caregivers can result in lower levels of wellbeing, depression, and social isolation. Rehabilitation professionals should screen stroke caregivers for activity loss and assist them in resuming their valued activities and maintaining their social contacts.

The lived experience of supporting people with mild stroke

Background: Mild stroke occurrences are rising and in order to comprehensively understand the experience of this health phenomenon, the context in which people with mild stroke live must be explored. Spouses are an important part of the lives of this population, but their experiences are yet to be fully understood.Aims/Objectives: To answer the question: "What is the essence of the mild stroke experience from the perspective of spouses during the first 9-months after acute hospital discharge, in Australia?"Materials and Methods: Qualitative study involving four spouses at 9-months post-acute hospital discharge for their family member. Interpretative phenomenological analysis used to analyze interview transcripts.Results: Two themes identified: (1) Activities gained but time lost, and (2) Small changes but big impacts. The first theme portrays the increase in daily activity that spouses experienced due to caregiving related activities, which impacted on their occupational participation. The second highlights the impact that people with mild strokes' behavioral and emotional changes can have on spouses.Conclusions and Significance: Whilst spouses generally return to their daily routines after a family members' mild stroke, some will experience increased time pressures and occupational disruptions. Health providers should prepare spouses for behavioral and emotional changes in people with mild stroke.

"Just got to live life as it comes": A case study of the spousal-dyad longitudinal mild stroke transitional experience

Objective: To longitudinally explore the transition home for a spousal dyad following mild stroke, in the context of a mild stroke-specific health service. Research Design: A case study approach, using an Interpretative Phenomenological Analysis (IPA), was identified as suitable for this study, as it enabled the essence of the phenomenon to be examined. Method: Participants were purposively chosen from a Randomised Control Trial (RCT), to reflect the average age, gender and marital status of the mild stroke population. The participants were a male (age 64) and his wife (age 62). Participants received the RCT intervention. Semi-structured interviews were completed separately with participants at 1-, 3-, 6- and 9- months post stroke. Results: Two themes were identified: (1) The Unexpected, Undesirable and Short-Lived, and (2) The New 'Normal'. The first theme reflects the confusion, adjustment and adaptation that occurred for the couple, especially during the first month at home. The second represents the couple's journey back to their everyday lives following hospital discharge, but also the questions and changes that remained present at 9-months post-discharge. Conclusions: Themes demonstrate an ongoing process of adjustment and the contextual nature of the transitional experience. Results also indicate the need to ensure that individuals have access to mild-stroke specific information across the transition continuum.

Quality of life perceptions of family caregivers of older adults stroke survivors: A longitudinal study

BACKGROUND

There are few formal outreach and out-patient support services to help family caring for older adults who have had a stroke in developing countries. Family caregivers experience negative changes in their quality of life.

AIM

To assess quality of life perceptions of spouse and non-spouse caregivers of older adult stroke survivors.

METHODS

A longitudinal survey study. A convenience sample of forty-eight family caregivers was recruited from the Special Care Stroke Unit at a University Hospital in South Brazil. Quality of life was measured using the World Health Organization's Quality of Life BREF survey upon discharge from the hospital (Time 1) and two months after (Time 2).

RESULTS

Non-spouse caregivers had the lowest Social Relationship scores at Time 1 (p < .001) and at Time 2 (p = .005), both in terms of personal relationship, the quality of their sex lives and support received from others.

CONCLUSION

Unfortunately, formal community support programs for family caregivers in Brazil are lacking. Post-stroke caregiving is largely a family affair. Quality of Life assessments among family caregivers of older adult stroke survivors are crucial, particularly after discharge.

The role of the GP in managing suspected transient ischaemic attack: a qualitative study

BACKGROUND

National guidelines recommend patients with suspected transient ischaemic attack (TIA) should be seen by a specialist within 24 h. However, people with suspected TIA often present to non-specialised services, particularly primary care. Therefore, general practitioners (GPs) have a crucial role in recognition and urgent referral of people with suspected TIA. This study aims to explore the role of GPs in the initial management of suspected TIA in the United Kingdom (UK).

METHODS

One-to-one, semi-structured interviews with GPs, TIA clinic staff and patients with suspected TIA from two sites in the UK: Cambridge and Birmingham. Thematic analysis was undertaken to explore views on the role of the GP in managing suspected TIA. Thirty semi-structured interviews were conducted with stroke patients (n = 12), GPs (n = 9) and TIA clinic hospital staff (n = 9) from two hospitals and nine GP practices in surrounding areas.

RESULTS

Three overarching themes were identified: (1) multiple management pathways for suspected TIA; (2) uncertainty regarding suspected TIA as an emergency or routine situation; and (3) influences on the urgency of GP management.

CONCLUSIONS

Guidelines on the primary care management of TIA describe only a small proportion of the factors which influence GP management and referral of suspected TIA. Efforts to improve treatment, appropriate referral and patient experience should use a real rather than idealised model of the GP role in managing suspected TIA.

Emotional and social repercussions of stroke on patient-family caregiver dyads: Analysis of diverging attitudes and profiles of the differing dyads

For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple 'patient/family caregiver' are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients' impaired functions) to identify the differing dyadic profiles. Family caregivers' and patients' attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other's attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies.

How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies

Objective:

To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors.

Methods:

MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team.

Results:

The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss.

Conclusion:

Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.

Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors

Individuals with mild strokes are generally considered fully functional and do not traditionally receive rehabilitation services. Because patients with mild stroke are assumed to have a good recovery, they may have deficits in other areas, including mental health, that are not addressed. As a result, patients with mild stroke are unable to meet quality of life standards. In addition, healthcare professionals are likely unaware of the potential mental health issues that may arise in mild stroke. To address this gap in knowledge, we review the evidence supporting mental health evaluation and intervention in mild stroke. Specifically, we review comorbid diagnoses including depression, anxiety, fatigue, and sleep disturbances and their potential effects on health and function. Finally, we conclude with general recommendations describing best practice derived from current evidence.

Mediating effects of burden on quality of life for caregivers of first-time stroke patients discharged from the hospital within one year

Background

Caregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients.

Methods

This is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis.

Results

A total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of $ 666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden.

Conclusions

Our study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers’ financial factors affected caregiver QoL directly. Caregivers’ poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers’ health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

Real-life experiences of people with transient ischaemic attack or minor stroke: A qualitative literature review

AIMS AND OBJECTIVES

To explore and present findings of qualitative studies exploring real-life experiences of people with transient ischaemic attack or minor stroke.

BACKGROUND

Transient ischaemic attack and minor stroke significantly increase the risk of stroke. Primarily, literature has examined healthcare pathways, patient outcomes and models of care through quantitative methodologies. Several studies have explored patient experiences using qualitative approaches. However, these findings have not been systematically collated or critically appraised to better understand the experiences of this population.

DESIGN

A literature review of the qualitative evidence.

METHOD

A systematic literature search was conducted in CINAHL, MEDLINE, EMBASE and PsycINFO between January 2005-October 2016 to identify qualitative studies that explored real-life experiences of people with transient ischaemic attack or minor stroke. The relevant EQUATOR guidelines were followed. Findings of relevant studies were critically appraised and collated using a thematic approach.

RESULTS

The search retrieved 709 articles. Twelve articles were included after critical review. Three themes emerged including recognition, awareness and action; the vulnerable self; and social and personal life change. Participants experienced ongoing vulnerability and change in their personal and social lives. Specifically, people believed that their condition did not reflect their physical appearance and led to their needs being unmet by health professionals.

CONCLUSIONS

This is the first review of the literature to collate the thoughts, perspectives and experiences of people living with transient ischaemic attack or minor stroke. They reveal a complex, life-altering experience characterised by vulnerability, instability and change. Education that assists clinicians to connect with these experiences may alleviate the patient-reported disconnection with health professionals.

RELEVANCE TO CLINICAL PRACTICE

Physical and psychosocial dysfunctions were consistently reported to be overlooked or undetected by clinicians. Educating clinicians might enable them to better understand patient experiences, improve therapeutic interactions and meet the needs of this population.

Return to work predictors of stroke survivors and their spousal caregivers

BACKGROUND

Return to work is an issue of concern for stroke survivors and their spouses. Ramifications may include loss of income and self-efficacy.

OBJECTIVE

This study describes the return to work patterns of stroke survivors and their spousal caregivers post stroke.

METHODS

One hundred fifty-nine dyads were examined for their return to work patterns at baseline (post hospital discharge) and then at 3 month intervals for one year. Relationships were determined between work and gender, age, ethnicity, education, type of insurance, type of stroke, location of stroke, motor and cognitive functional status, depression, mutuality, and life satisfaction.

RESULTS

Low levels of return to work by stroke survivors (7.5%) and a small decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year post baseline. Variables that predicted return to work changed over the five data points except for younger age for the caregiver, which was consistently significant across all data points. Three case scenarios representative of working patterns are offered.

CONCLUSIONS

Further research is needed regarding the return to work needs of stroke survivors and their spousal caregivers, particularly what role the occupational therapist may play in facilitating that process.

Needs of Stroke Survivors as Perceived by Their Caregivers: A Scoping Review

OBJECTIVE

Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers.

DESIGN

A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion. The data extracted from these studies were synthetized into metathemes.

RESULTS

Fifty-two qualitative, ten quantitative survey, and four mixed-methods studies were included in the final synthesis. The studies came from 11 countries. The data synthesis produced following three metathemes: (a) body functional needs, including psychological function, physical function, cognitive function, and uncertainty related to function; (b) activity and participatory needs, including healthy lifestyle, physical activities, speech, independence, cognitive activities, and uncertainty related to activities and participation; and (c) environmental needs, encompassing support, services, safety, accommodation and accessibility, and uncertainty related to environmental factors.

CONCLUSIONS

This scoping review identified a range of needs of stroke survivors as perceived by their caregivers. Incorporating the caregiver's preferences and values into clinical decisions may improve outcomes among stroke survivors.

Marriage after the transition to stroke: a systematic review

In health and chronic illness, satisfying marriages promote wellbeing and life satisfaction, yet stroke research has focused on either the stroke survivor as the patient or the spouse as a care-giver. Using Pope, Mays and Popay's framework for synthesising qualitative and quantitative methods, we conducted a systematic review and synthesis of 39 peer-reviewed studies to determine what happens to marital relationships after one partner has suffered a stroke. All the articles examined the impact of stroke. Three overarching themes characterise the evolution of marriage after stroke: chaos in the marriage, work to re-establish the marriage and evolution of the marriages. While both the stroke condition itself and the survivors’ need for care undermined the emotional qualities of the relationship for some couples, about two-thirds were able to retain or regain the relationship closeness. As in other chronic illnesses, the relationship closeness and a couple's ability to collaborate contributed to the survivor's recovery and to the satisfaction with life of the stroke survivor and the spouse. Our results underscore the need to consider the quality of, and the qualities of, the relationship between stroke survivors and their spouses. Future research could include a greater focus on qualitative or mixed-methods approaches to explore the interactions between stroke survivors and spouses that impact the wellbeing of both partners.

A qualitative investigation of sense of self and continuity in younger adults with stroke

Younger adults are more likely to survive after stroke and their life trajectory is often disrupted. This qualitative study aimed to explore the experience of sense of self and continuity in younger adults after stroke. In-depth semi-structured interviews were conducted with 10 adults (3 male, 7 female) with stroke onset between 18 and 55 years of age. Their interview transcripts were analysed using a phenomenological approach that involved idiographic and nomothetic stages of analysis. Two major themes emerged: (1) centrality of stroke; and (2) impacts of stroke on self. The first theme relates to how central the stroke is in participants' lives. The second theme depicts ways in which stroke influences participants' sense of self. In general, participants who perceived their stroke as having lower centrality also experienced continuity of self, whereas participants who viewed their stroke as higher in centrality experienced interruption of self which often co-existed with growth of self. However, perceptions of stroke centrality and the impacts on self shifted over time and context. These findings extend conceptualisations of post-stroke adjustment by indicating that the impact of stroke on sense of self during early to middle adulthood is linked to how central people perceive their stroke to be within their life story. Younger adults may simultaneously experience their sense of self as continuous, interrupted, and grown after stroke.

Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke

We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.

Calidad de vida de los cuidadores de personas con enfermedad crónica

El alto impacto epidemiológico, social, económico y cultural de las enfermedades crónicas no transmisibles afecta el significado de calidad de vida en las personas que las padecen y en sus cuidadores familiares. Objetivo: describir la forma como se construye el significado de calidad de vida de cuidadores de personas con enfermedad crónica. Método: investigación desarrollada con la propuesta de metasíntesis cualitativa de Sandelowski y Barroso. Resultados: se presentan tres momentos en la trayectoria: 1) se afecta (destrucción celular programada); 2) se trasforma (autocontrol del desarrollo y crecimiento), y 3) se resignifica (condensación); y cuatro factores condicionantes para la construcción del significado de calidad de vida para el cuidador como son el soporte social, la espiritualidad, la habilidad para cuidar y el tiempo. Conclusiones: la calidad de vida se afecta y se reconstruye en virtud del significado que el cuidador tenga de esta.

Holistic Health Status Questionnaire: developing a measure from a Hong Kong Chinese population

BACKGROUND

The increased prevalence of chronic diseases is a global health issue. Once chronic disease is diagnosed, individuals face lifelong healthcare treatments, and the disabilities and disturbances resulting from their illness will affect the whole person. A valid tool that can measure clients' holistic care needs is important to enable us to identify issues of concern and address them early to prevent further complications. This study aimed to develop and evaluate the psychometric properties of a scale measuring holistic health among chronically ill individuals.

METHODS

The research was an instrument development and validation study using three samples of Hong Kong Chinese people. The first sample (n = 15) consisted of stroke survivors who had experienced disruption of their total being, and was used as a basis for the generation of scale items. In the second and third samples (n = 319, n = 303), respondents with various chronic illnesses were assessed in order to estimate the psychometric properties of the scale. A total of 52 items were initially generated, and 7 items with a factor loading less than 0.3 were removed in the process, as substantiated by the literature and expert panel reviews.

RESULTS

Exploratory factor analysis identified a 45-item, 8-factor Holistic Health Status Questionnaire (HHSQ) that could account for 56.38 % of the variance. The HHSQ demonstrated content validity, acceptable internal consistency (0.59-0.92) and satisfactory convergent validity from moderate to high correlation with similar constructs (r ≥ 0.46, p < 0.01).

CONCLUSIONS

The HHSQ tapped into the relational experiences and connectedness among the bio-psycho-social-spiritual dimensions of a Chinese person with chronic disease, with acceptable psychometric properties.